insurance

Insurance Claim

保険請求 (hoken seikyū)

An insurance claim is a formal request submitted to an insurer for payment of a covered health service. For in-network care, the provider typically submits the claim directly on behalf of the patient. For out-of-network care, the patient may need to submit the claim themselves with supporting documentation. Claims are reviewed for eligibility, coverage, and medical necessity. If a claim is denied, patients have the right to appeal — first through the insurer's internal process, then through external review by an independent organization.

Keeping records of all medical visits, bills, and EOBs makes it easier to dispute incorrectly denied claims or billing errors.

In 9 languages

Language	Term
English	Insurance Claim
Japanese (日本語)	保険請求
Chinese (中文)	保险理赔
Korean (한국어)	보험 청구
Portuguese	Sinistro de Seguro
Spanish	Reclamación de Seguro
Filipino	Insurance Claim
Thai	การเรียกร้องสิทธิ์ประกัน
Vietnamese	Yêu cầu bồi thường bảo hiểm
Romanization	hoken seikyū

Related terms

• Itemized Medical Bill 診療明細書
• Explanation of Benefits (EOB) 給付内容説明書（EOB）
• In-Network Provider ネットワーク内プロバイダー
• Prior Authorization 事前承認
• Itemized Medical Bill 明細書（医療費）

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